Pregnancy outcomes in women aged 35 years or older with gestational diabetes - a registry-based study in Finland

Objective: To compare pregnancy outcomes of women ≥ 35 years to women <35 years with and without gestational diabetes.

Methods: The data include 230,003 women <35 years and 53,321 women ≥ 35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28-31 and 32-36 weeks' gestation), Apgar scores <7 at 5 min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA).

Results: In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30-1.88), admission to the NICU (OR 3.30, CI 2.94-3.69) and shoulder dystocia (OR 2.12, CI 1.05-4.30) were highest in insulin-treated women ≥ 35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73-3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant.

Conclusions: GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia.